Nutritional Risk Index predicts mortality in hospitalized advanced heart failure patients

JOURNAL OF HEART AND LUNG TRANSPLANTATION

卷:34

Article

Adejumo, Oluwayemisi L.¹  Koelling, Todd M.¹  Hummel, Scott L.^1,2 

[1] Univ Michigan Hlth Syst, Frankel Cardiovasc Ctr, Ann Arbor, MI 48109 USA

[2] Ann Arbor Vet Affairs Hlth Syst, Ann Arbor, MI USA

关键词: heart failure;    mortality;    nutrition;    cachexia;    risk model;   

DOI  :  10.1016/j.healun.2015.05.027

来源: Elsevier

【 摘 要 】

BACKGROUND: Hospitalized advanced heart failure (HF) patients are at high risk for malnutrition and death. The Nutritional Risk Index (NRI) is a simple, well-validated tool for identifying patients at risk for nutrition-related complications. We hypothesized that, in advanced HF patients from the ESCAPE (Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness) trial, the NRI would improve risk discrimination for 6-month all-cause mortality. METHODS: We analyzed the 160 ESCAPE index admission survivors with complete follow-up and NRI data, calculated as follows: NRI = (1.519 x discharge serum albumin [in g/d11) -I- (41.7 x discharge weight [in kg] / ideal body weight [in kg]); as in previous studies, if discharge weight is greater than ideal body weight (IBW), this ratio was set to I. The previously developed ESCAPE mortality model includes: age; 6-minute walk distance; cardiopulmonary resuscitation/mechanical ventilation; discharge beta-blocker prescription and diuretic dose; and discharge serum sodium, blood urea nitrogen and brain natriuretic peptide levels. We used Cox proportional hazards modeling for the outcome of 6-month.allcause mortality. RESULTS: Thirty of 160 patients died within 6 months of hospital discharge. The median NRI was 96 (IQR 91 to 102), reflecting mild-to-moderate nutritional risk. The NR1 independently predicted 6-month mortality, with adjusted HR 0.60 (95% CI 0.39 to 0.93, p = 0.02) per 10 units, and increased Harrell's c-index from 0.74 to 0.76 when added to the ESCAPE model. Body mass index and NRI at hospital admission dichnot predict 6-month mortality. The discharge NRI was most helpful in patients with high ( > 20%) predicted mortality by the ESCAPE model, where observed 6-month mortality was 38% in patients with NRI < 100 and 14% in those with NRI > 100 (p = 0.04). CONCLUSIONS: The NRI is a simple,tool that can improve mortality risk stratification at hospital discharge in hospitalized patients with advanced HF. Published by Elsevier Inc.

【 授权许可】

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